永久性左束支区域起搏患者冠状动脉疾病的影响：一项回顾性研究。
Effects of coronary artery disease in patients with permanent left bundle branch area pacing: A retrospective study.
作者信息
Shan Yu, Lin Maoning, Ye Miao, Shen Xiaohua, Li Duanbin, Chen Zhezhe, Jiang Hangpan, Fu Guosheng, Zhang Wenbin, Wang Min
机构信息
Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China.
Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.
出版信息
Heliyon. 2024 Jan 11;10(2):e24226. doi: 10.1016/j.heliyon.2024.e24226. eCollection 2024 Jan 30.
AIMS
Myocardial ischemia can affect traditional right ventricular (RV) pacing parameters, but it is unclear whether coronary artery disease (CAD) impact the pacing parameters and electrophysiological characteristics of left bundle branch area pacing (LBBaP) as a physiological pacing representative.
METHODS
Patients who underwent coronary angiography (CAG) after/before the LBBaP procedure and underwent percutaneous coronary intervention after LBBaP procedure were divided into CAD group and Non-CAD group according to visual CAG. Pacing parameters and electrophysiological characteristics were recorded at LBBaP implantation. Multivariate logistic regression analysis was implemented to evaluate the association between CAD and higher capture threshold. Sensitivity analyses were conducted to verify result stability.
RESULTS
A total of 176 patients met inclusion criteria (115 Non-CAD patients and 61 CAD patients) with a mean age of 71.1 ± 9.0 years. Compared with the Non-CAD patients, CAD patients had the higher capture threshold (0.67 ± 0.22 V vs. 0.82 ± 0.28 V, P < 0.001) and lower R-wave amplitude (12.5 ± 4.8 mV vs. 10.1 ± 2.7 mV, P = 0.001). Moreover, CAD was independently associated with higher capture threshold (adjusted Odds ratio (OR) 3.418, 95% confidence interval (CI): 1.621-7.206, P = 0.001), which was further validated through sensitivity analyses.
CONCLUSION
Patients without CAD might have safer pacing parameters in the LBBaP procedure. Besides, CAD might be the risk factor of capture threshold increase during permanent LBBaP implantation.
目的
心肌缺血可影响传统右心室起搏参数，但冠状动脉疾病（CAD）作为生理性起搏的代表，是否会影响左束支区域起搏（LBBaP）的起搏参数和电生理特性尚不清楚。
方法
在LBBaP手术前后接受冠状动脉造影（CAG）且在LBBaP手术后接受经皮冠状动脉介入治疗的患者，根据CAG结果分为CAD组和非CAD组。在LBBaP植入时记录起搏参数和电生理特性。采用多因素逻辑回归分析评估CAD与较高起搏阈值之间的关联。进行敏感性分析以验证结果的稳定性。
结果
共有176例患者符合纳入标准（115例非CAD患者和61例CAD患者），平均年龄为71.1±9.0岁。与非CAD患者相比，CAD患者的起搏阈值更高（0.67±0.22V对0.82±0.28V，P<0.001），R波振幅更低（12.5±4.8mV对10.1±2.7mV，P=0.001）。此外，CAD与较高的起搏阈值独立相关（调整后的比值比（OR）为3.418，95%置信区间（CI）：1.621-7.206，P=0.001），敏感性分析进一步验证了这一结果。
结论
无CAD的患者在LBBaP手术中可能具有更安全的起搏参数。此外，CAD可能是永久性LBBaP植入期间起搏阈值升高的危险因素。
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